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Aortic dissection complicating cardiac surgery in a patient with calcified ascending aorta
Y Sakakibara1, K Matsuda, F Sato
1Department of Surgery, University of Tsukuba, Ibaraki, Japan.
Insights
Intraoperative aortic dissection during cardiac surgery can be diagnosed with transesophageal echocardiography. Early diagnosis and prompt intervention, like switching perfusion sites, can save patients.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Thoracic Surgery
Background:
- Aortic dissection is a rare yet severe complication following cardiac surgery.
- Prompt diagnosis and management are critical for patient survival.
- Severe calcification of the ascending aorta presents unique surgical challenges.
Observation:
- A 68-year-old male patient undergoing coronary artery bypass grafting (CABG) and mitral valve replacement experienced intraoperative aortic dissection.
- Transesophageal echocardiography (TEE) was instrumental in diagnosing the dissection and identifying malperfusion of the true lumen.
- The patient had severe calcification of the ascending aorta.
Findings:
- Immediate switching of the arterial perfusion site successfully restored flow to the true lumen.
- The expanded false lumen promptly subsided after the perfusion site was altered.
- Simultaneous performance of CABG, mitral valve replacement, and ascending aorta graft replacement was feasible.
Implications:
- TEE is a valuable tool for the real-time diagnosis of intraoperative aortic dissection.
- Altering the arterial perfusion strategy can effectively manage aortic dissection during surgery.
- Complex cardiac procedures, including aortic repair, can be performed simultaneously in select cases.
Abstract:
Aortic dissection is a rare but devastating complication of cardiac surgery. Adequate and early diagnosis of intraoperative aortic dissection and quick therapeutic decision making are the keys for saving patients in such cases. We describe the case of a 68-year-old man referred for CABG and mitral valve replacement with severe calcification of the ascending aorta. Intra-operative transesophageal echocardiography was useful for diagnosis of intra-operative aortic dissection and malperfusion of the true lumen. Immediate switching of the arterial perfusion site established flow in the true lumen with prompt subsidence of the expanded false lumen. CABG, mitral valve replacement and graft replacement of the ascending aorta could be simultaneously performed in this patient.